By Jyoti Kuikel
First of all, I am truly grateful to Research Team of HERD for giving me the opportunity to be a part of the project entitled, “MMR Baseline Survey.” From September 5, 2018 I was appointed as a Field Researcher for Solukhumbu. Thankfully, I was able to collect wonderful and unexpected experiences. Some of them were great learnings and some still create goosebumps. However, all of these experiences are added to my memory.
A day before field movement, I had a thought; the thought of my destination-Solukhumbu. From the previous field experiences, I knew that these visits are not easy. The challenges, hindrances, trekking whole day long, empty stomach, sleepless nights were all over my head. Besides, this time the place was Solukhmbu; the place of mountains. I had predicted that it would be cold with slippery roads. So, I had packed my bag accordingly. All those cloudy thoughts about new place, new culture and climate were making me happy, super excited and nervous at the same time.
My research partner and I were assigned for two municipalities: Solududhkunda Municipality and Likhu Pike Rural Municipality. These two places became the opportunity for me to learn about the situation. How? That I will explain later. Most of the people in Solududhkunda municipality told us that we were lucky to be in the municipality. But that wasn’t true. The municipality was so large geographically and had scattered houses. Even a single ward was divided in such a way that we had to go through many hills; ups and downs. It used to take half a day just to reach the place. After completing the task of Solududhkunda then I came to realize that Salleri- headquarter of Solukhumbu was the only place that people were talking about. They had generalized simply by seeing the facilities of Salleri as Solududhkunda. We visited almost all the corners of Solududhkunda (all the 11 wards) to identify the mortality cases as well as to interview recently delivered women (RDW).
I was only new to the place but my team member was new to everything. That is why I had to manage each and every activity in that place. I was imposed to fix the meeting, coordinate with the health personnel, contact and communicate with them, conduct the meeting, write down the minutes, list the RDWs and mortality cases, make the work plan, write field diary, and walk with her in every interviews. However, I was never bored of all these stuffs because I was learning from all these activities. In addition, she helped me in conducting interviews with RDW.
In the Solududhkunda Municipality, we were assigned for Ward Nos. 5 [Salleri] and 6 [Dorpu] for the RDW. Both of these areas were geographically large extending from high hills to river bank and then to the next village across the river. So, we decided to include sample from each of the place such that we will be able to cover the whole ward. More than systematic sampling, it was purposive sampling such that we could include the perception of people from each area with the aim that 15 RDW in each ward would represent the whole ward.
In Likhu Pike Rural Municipality, we were assigned for Ward Nos. 1 and 2 [Goli] for RDW. We identified that there was diversity in ethnic group. The majority of them were Chhetri and Sherpa. The minority groups were Tamang, Brahmin and Bishwokarma. When we counted the RDW of Ward 1, it was not enough for collecting 15 RDWs. We were more interested in including all these ethnic groups rather than just going through the numbers. So, the respondents were selected proportionally such that every single caste and their perception towards the knowledge and practice for neonatal care would be included.
Opportunities and Challenges
There were some of the opportunities in Solududhkunda Municipality and Likhu Pike Rural Municipality and I would like to list them:
- Our Team leader stayed with our team for certain period of time and he made us learn how to coordinate with stakeholders in meetings and marked the importance of minute as it is the major source of evidence.
- The health coordinator of the municipality was helpful and supportive. He helped us to enlist the numbers and names of all the RDW of the assigned wards; 5 and 6. Furthermore, he had informed most of the Health Post In-charge about our arrival to their respective health posts.
- The FCHVs of ward 6 were helpful as they used to walk with us to conduct interviews with RDW and mortality cases.
- Salleri being the center place for the mobility, we did not have to carry our luggage for 10-15 days and that was helping us.
- It was so easy for us to travel to Garma Health Post due to road accessibility and we could go there through the vehicle.
- The meeting conducted in Gorakhani Health Post was really the best meeting as there was no mortality case.
- In case of Tingla, the respondent of NMR had migrated to Salleri, so it made us easier as we had to return to Salleri for visiting other places, and our time (a day!) wasn’t consumed for conducting interview.
- There were fewer mortality cases, around 17, identified in this municipality.
- In case of Likhu Pike, Immunization Day for two days and Sarbottam Pitto distribution for a day made us easier to collect the RDWs. A staff of SUAAHARA Project was so helpful; she assisted in identifying the RDW as she was also involved in the similar work.
- There were not many cases in Likhu Pike Rural Municipality, so we were able to complete faster.
There were many threats while conducting the assigned task in these municipalities, as enlisted below:
- Time Management: Due to different days like Teej and Saturdays, our work was going too slow. It took around 2 days simply to get the approval letters from the authority i.e. District Health Office (a day) and from municipality office (a day).
- The female staff of municipality health department was less interactive. She knew many things about the municipality but didn’t share much.
- In the first HP meeting, HP staff and ANM talked rudely with us just because the money for the snack was less than she had expected. After a long talk, she finally allowed us to conduct the meeting.
The abandoned woman
There’s an incident at Kerung. I still remember the words that an old respondent used when we visited her for the interview. She was really rude. But her rudeness had lots of pain-sufferings, weaknesses and burden to rare grandchildren. Her daughter-in-law had died (MMR) while giving birth to a baby. Her son had re-married and migrated Kathmandu. There were two grand-children that those two old couple had to look after. They had no source of income.
The death of her daughter-in-law was about two years ago. And in these time interval, the old lady had talked to many organizations. They used to come, ask her and assure her that they would help but none of the organization returned back to help that family. She was frustrated and hated organizations, and we happened to meet her. She denied us, yet I tried to convince her so much. I even had to give some of my own life examples and my sufferings but she didn’t speak a word. That was a refusal case for us. We were so sad at that time. It was already so dark that we had no place to go. And she wasn’t ready to give us the shelter. We had travelled to her place in a hope that she would give us shelter but she was not in that mood. At that moment, I happened to remember my home, my room and my bed. Both of us had no idea about where would we go.
We were taken to that lady’s home by ANM of Kerung HP. On the way, she had told that she was going somewhere else. And she didn’t have enough rooms in her home. Dark everywhere and cold weather; sweat engulfed wet clothes, no cellular network. It was one of the worst experiences in my life. Finally, after a long wait, we found a place to hide our head.
We, the unfortunates
The next incident happened in Tapting. We identified two mortality cases. We were quite happy that there were only two cases. Unfortunately, those places were too far from the Health Post. According to the Health Post In-charge, it would take a whole day to reach the place. Anyhow, we had to go there. When we asked about the FCHVs, he told that there were no FCHVs with access to cell phones. So, we had to go there on our own. On the way, we lost the direction. We tried to call the In-charge, but there was no network as usual. We were inside the dense forest and it took around three hours to find our way. We had walked since 6:45 a.m; empty-stomach. Hungry and tired; it took around 6 hours for us to reach one of the places with mortality case. We were taking rest and there we happen to meet a teacher of that place. When we were having informal talks, she told that the family is no longer living there. Some members had moved to Kathmandu and the respondent of NMR had moved to Lukla (Khumbu Rural Municipality). I felt so sad at that time that I felt of jumping from the hill (where we were standing). Then without any delay, we moved to next place. And the next place was double the first way. Fortunately, there was a shop where we bought a packet each of biscuit and juice. Asking about direction with the local people, we kept on walking without a pause. Both of us were so tired that we weren’t even talking with each other just to save our energy and to focus on walk on that sunny day. And that was making us more difficult to walk. The road was straight upward and the house we had to reach was on the top of that hill. We finally reached there after 8-9 hours. And then took rest in the house of the respondent and took the interview. Then on the same day, we returned to the hotel where we were staying. All the people of that place were shocked to see us because we were the only one who had went to that place in the same day and returned. We had no option than to return because we were determined to finish the work on time anyhow.
Facing the rude people
The next incident in Tamakhani was the scariest moment. We were told that Tamakhani was about an hour away from Salleri. So, we moved in the place at 10:30 a.m. after having lunch. But it took us around 3 hours of walk to finally reach the place. That day also was sunny and road was sandy; Oh how I still feel that burn! It was burning and that burn was reflecting in our faces and legs. About everything had different feel in that place, lest it be wind. Even the river of that area was clean green which was weird yet beautiful. There was not a single person in the road except us. Not even a single house. Both of us were talking about the way and its weirdness.
It was around mid-noon when I received a call. That call was from the AHW of Tamakhani HP. She started scolding me and started telling that we hadn’t informed District Health Office. I was shocked to hear that. She even complained that I hadn’t informed to Health Coordinator. She told me that we weren’t allowed to go to her HP without the permission from the District Health Office and municipality office. She told me to return immediately.
I was shocked to hear all those stuffs. How could she simply blame someone without any evidences? I politely told her that I had the approval from DHO as well as municipality office and we were on the way to HP, so we would come there and have a talk. It was around 1:00 p.m. when we reached there and all the FCHVs were sitting outside the office room. We talked to the AHW and provided her the letters of recommendation from DHO and municipality office. Then they behaved somewhat politely.
But still they were being rude to us for arriving late. They were in search of our flaws rather than the concern of our visit. It was because the ANM of the HP who had been working since last 20 years never stayed in the HP and AHW was newly recruited.
The HP In-charge had recently transferred and they were in fear that the people from district were coming to investigate them. It was around 1:15 p.m. when we started our meeting.
The bear attack
Right then, we heard a phone call to one of the FCHVs that the bear had attacked a man. All of them were outside to look at the case. We were also curious to see the injured man just brought in the HP. I had never ever seen such accident and ensued injuries before; not even a person bleeding. And I don’t know why but I cannot look at blood. But I happened to see such a case. That was like, oh my god! I was feeling to cry so hard.
The man was immediately referred to district hospital. After an hour, we got hold of all FCHVs. We were scared and numb. We didn’t want to do anything at that moment. But despite of all the emotions, we went ahead with the meeting. I probed each FCHV and we could finally identify 3 cases.
Now the biggest deal was that, two of them were from the place where the bear had attacked the people. We had to go through the same jungle. Few weeks ago, two girls were seriously injured in the same place and the next was that man.
We asked with the policeman to take us to the place, he told that he would rather hand us his gun but wouldn’t go with us. Later on we came to find that the way from where we had reached the HP was the most prevalent area for bear to walk!
Above the clouds
The next was Taksindu. It was the longest walk that we had. It was a whole day’s walk to reach the HP. We had started our journey from a hot point, at the riverbank, and we reached to the cold area, hilltop above the clouds. Then we again walked down to the other side of hill, then to the next hill and many more. It took exactly a day. We had started walking at 5:45 am and it was around 7:00 pm when we reached place. We went on walking without a rest, not even for a meal. It was like never ending walk. The whole legs were numb. It was extreme pain. We were stinking because of sweat. People must be true that we were the luckiest team because we experienced everything.
In case of Likhu Pike, reaching that rural municipality alone was a long distance. It took us around two days to reach the place.
So, this field visit was the most wonderful one; I learned a life. The hills taught me about the ups and downs we had in our lives. We all face both things: joy and sorrow. Similarly, if there was a linear road, then it was end of hill, similar to straight line of heartbeat indicating death.
A sentence by Hillary Clinton is so true, “If you want to know how strong a country’s health system is, look at the wellbeing of its mothers.”
And, thank you once again HERD for letting me participate in this research. It helped to make myself clear about where our health system stands.